Tracking for underweight, overweight and obesity from childhood to adolescence: a 5-year follow-up study in urban Indonesian children.

AIMS: To assess tracking of body mass index (BMI) of urban Indonesian children from childhood to adolescence and to compare the prevalence of underweight, overweight and obesity in 6- to 8-year-old children from two surveys: years 1999 and 2004. METHODS: A longitudinal study assessing BMI tracking of 308 urban children followed from age 6-8 to 11-13 years and two cross-sectional surveys comparing the prevalence of underweight, overweight and obesity in 6- to 8-year-old children: year 1999 (n = 1,524) and 2004 (n = 510). RESULTS: Childhood BMI determined 52.3% variation of later BMI. After 5.1 (0.6) years the prevalence of overweight and obesity increased from 4.2 and 1.9% in childhood to 8.8 and 3.2% in adolescence. The prevalence of underweight decreased from 27.3 to 18.8%. All obese children remained obese, 84.6% overweight children stayed overweight, 56.0% underweight children remained underweight. In cross-sectional comparison the prevalence of overweight and obesity raised from 5.3 to 8.6% and from 2.7 to 3.7%, respectively. The prevalence of underweight remained constant. CONCLUSIONS: The prevalence of overweight and obesity increases as children grow into adolescence. Overweight or obese children are more likely to remain overweight or obese. Cross-sectional comparison shows, while the prevalence of underweight stays constant, the prevalence of overweight and obesity increases.

Influence of socioeconomic status on the prevalence of stunted growth and obesity in prepubertal Indonesian children.

This cross-sectional study assesses the prevalence of stunting, overweight, and obesity in prepubertal children from different socioeconomic groups in Indonesia. Children from rural, poor urban, and nonpoor urban communities were studied (n = 3,010). The prevalences of stunting, wasting, overweight, and obesity were 19.3%, 5.0%, 2.7%, and 0.8%, respectively. The odds ratios (OR) for stunting, as compared with nonpoor urban children, were higher among rural children (2.92; 95% confidence interval [CI], 2.37-3.59) than among poor urban children (1.58; 95% CI, 1.18-2.13). The prevalence of wasting was not influenced by socioeconomic status. Both rural and poor urban children were significantly less likely to be overweight than were nonpoor urban children: in comparison with nonpoor urban children, the OR values were 0.19 (95% CI, 0.10-0.36) for rural and 0.13 (95% CI, 0.04-0.43) for poor urban children. Boys were more likely to be stunted or obese than girls: OR for stunting, 1.75 (95% CI, 1.44-2.12); OR for obesity, 4.07 (95% CI, 1.40-11.8). Stunted children were less likely than non-stunted children to be overweight: OR, 0.10 (95% CI, 0.03-0.43). In Indonesia, undernutrition is still related to poverty, whereas obesity is more related to prosperity.

Nutrient intake and iron status of urban poor and rural poor without access to rice fields are affected by the emerging economic crisis: the case of pregnant Indonesian women.

OBJECTIVE: We evaluated the adequacy of nutrient intake in comparison with the Indonesian Estimated Average Requirement (EARs) among pregnant Indonesian women and explain the short-term effect of economic crisis on nutrient intake and iron status. DESIGN: Cross-sectional study. SETTING: Purworejo District, Central Java, located 60 km west of Yogyakarta Province, Indonesia. SUBJECTS: During the period from 1996 to 1998, up to six 24 h recalls were performed during the second trimester of pregnancy among 450 women. Nutrient intake and iron status was evaluated in relation to date of data collection relative to the economic crisis that emerged in August 1997. A computer program (Inafood) was developed to calculate nutrient intake. RESULTS: : Forty percent of the pregnant women were at risk of inadequate intake of energy and protein, and 70% were at risk of inadequate intake of vitamin A, calcium and iron even before the crisis. Our results also demonstrate an effect of short-term economic crisis on nutrient intake and iron status. When the crisis emerged, urban poor experienced a decrease in intake of most nutrients. During the crisis, rich women experienced a significant decrease in fat (P<0.05). Negative changes in fat density during crisis were experienced by the rich and the rural, poor, and access to rice field subgroups (P<0.01). A significant increase in carbohydrate densities was seen for the rich and rural, poor, and access to rice fields groups (P<0.05). Urban poor experienced decreased serum ferritin concentration (P<0.05), whereas rich women experienced a significant increase (P<0.05). CONCLUSIONS: Urban poor and rural poor landless women were most directly affected by the emerging economic crisis.

Energy intake during economic crisis depends on initial wealth and access to rice fields: the case of pregnant Indonesian women.

Starting in August 1997, Indonesia experienced a radical and rapid deterioration in its economy. Between 1996 and 1998, dietary intake during the second trimester was measured in 450 pregnant women in Purworejo, Central Java, Indonesia. Using six 24 h recalls we describe the consequences of the economic crisis on the energy intake of pregnant Indonesian women. Depending on the date of data collection, women were grouped into 'before crisis', 'transition' and 'during crisis'. Mean energy intake among groups was compared using ANOVA and Student's t-test. All groups of pregnant women already had a mean energy intake before the emerging crisis that was lower than the Indonesian recommended dietary allowances (RDA). Nevertheless, energy intake differed significantly among women with different education levels (P = 0.00) and from different socio-economic groups (P = 0.00). 'During transition', a significant decrease in energy intake was experienced by urban poor women (P = 0.01). Poor women with access to rice fields had a higher rice consumption than other groups throughout the period. Our results most likely reflect the effect of higher rice price on income and welfare. 'During crisis', energy intake improved among vulnerable groups, perhaps reflecting government intervention.

Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings.

A randomized controlled trial was carried out for 1 y in three tertiary and teaching hospitals, in Addis Ababa (Ethiopia), Yogyakarta (Indonesia) and Merida (Mexico), to study the effectiveness, feasibility, acceptability and cost of kangaroo mother care (KMC) when compared to conventional methods of care (CMC). About 29% of 649 low birthweight infants (LBWI; 1000-1999 g) died before eligibility. Of the survivors, 38% were excluded for various reasons, 149 were randomly assigned to KMC (almost exclusive skin-to-skin care after stabilization), and 136 to CMC (warm room or incubator care). There were three deaths in each group and no difference in the incidence of severe disease. Hypothermia was significantly less common in KMC infants in Merida (13.5 vs 31.5 episodes/100 infants/d) and overall (10.8 vs 14.6). Exclusive breastfeeding at discharge was more common in KMC infants in Merida (80% vs 16%) and overall (88% vs 70%). KMC infants had a higher mean daily weight gain (21.3 g vs 17.7 g) and were discharged earlier (13.4 vs 16.3 d after enrolment). KMC was considered feasible and presented advantages over CMC in terms of maintenance of equipment. Mothers expressed a clear preference for KMC and health workers found it safe and convenient. KMC was cheaper than CMC in terms of salaries (US$ 11,788 vs US$ 29,888) and other running costs (US$ 7501 vs US$ 9876). This study confirms that hospital KMC for stabilized LBWI 1000-1999 g is at least as effective and safe as CMC, and shows that it is feasible in different settings, acceptable to mothers of different cultures, and less expensive. Where exclusive breastfeeding is uncommon among LBWI, KMC may bring about an increase in its prevalence and duration, with consequent benefits for health and growth. For hospitals in low-income countries KMC may represent an appropriate use of scarce resources.

Neonatal mortality in Yogyakarta rural areas.

PIP: The outcome of neonatal care was studied in 3 subdistricted rural areas in Yogyakarta Province with a total population of 112,075 people. All pregnancies and deliveries between May 1983-April 1984 were registered and seen twice during pregnancy, on delivery, and 5 days and 1 month postpartum by trained health personnel. There were 1819 singleton liveborn infants with a neonatal mortality rate of 25.3% in which 82.6% of the deaths occurred in the early neonatal period. 91.5% of the women delivered in their own homes and 83.9% were assisted by a traditional birth attendant (TBA) who was either trained or untrained. There were still 27.1% of the pregnancies which did not receive any antenatal care. 75.2% received tetanus immunizations and there was a 1.1% incidence of tetanus. The incidence of lowbirth infants was 8.1% among these, 19.7% died prior to 1 month of age and represented 63% of neonatal mortality. The causes of neonatal mortality were: birth asphyxia and hypoxia--56.5%; prematurity/low birthweight--13%; infection/sepsis--13% diarrhea--8.7%, tetanus neonatorum--4.4%, and other unknown causes--4.4%. In rural areas, TBAs play a key role in labor and in caring for mothers and their newborns up to 1 month of age. Clearly there is much needed improvement in health service delivery at all levels of the healthcare system, especially in the areas of resuscitation of newborns and in problems of low birthweight.^ieng